=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457359952
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES KEITH BAKER M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2005
-----------------------------------------------------
Last Update Date | 01/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1305 WONDER WORLD DRIVE SUITE 100
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78666-7502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-353-8658
-----------------------------------------------------
Fax | 512-353-8533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1305 WONDER WORLD DR STE 307
-----------------------------------------------------
City | SAN MARCOS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78666-7542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-353-8658
-----------------------------------------------------
Fax | 512-353-8533
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | M3153
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------